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Organization
PRIME CHOICE & CARE LLC
Active
Organization
PRIME CHOICE & CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARISSA RANDALL WALLACE (OWNER)
(863) 844-1735
Entity
Organization
Contact information
Practice address
11707 TETRAFIN DR, RIVERVIEW, FL 33579-4127
(863) 844-1735
Mailing address
11707 TETRAFIN DR, RIVERVIEW, FL 33579-4127
(863) 844-1735
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
Primary
—
NULL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
NULL
Other
Enumeration date
10/09/2026
Last updated
10/09/2026
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